SUNDAY, NOVEMBER 22 , 2020. THE WASHINGTON POST EZ RE A21
Provence, but whose age increas-
es his chances of covid-19 compli-
cations.
How do nations weigh other
risk groups? Obesity is a comor-
bidity for serious complications
from covid-19. Do the overweight
in the richest countries get to
jump the queue — or just the
seriously obese? What protec-
tions do Britain, or the United
States, owe to racial and ethnic
minorities who make up an out-
size portion of those dying?
Allocation decisions may crys-
tallize in the United States with a
decision by the Centers for Dis-
ease Control and Prevention
within days after vaccine approv-
al. The National Academies of
Sciences, Engineering, and Medi-
cine called addressing racial in-
equities a “moral imperative.”
Some countries also want to
target groups with the greatest
potential to spread the virus.
Prisons have been hot spots for
infection around the world. So
have universities. Would lower-
risk people be okay knowing they
rank below those who have com-
mitted crimes or partying stu-
dents who have been flouting
public health restrictions?
As the lists begin to emerge,
many nations agree that the first
priority should be front-line med-
ical workers, alongside first re-
sponders such as ambulance at-
tendants.
Even within the category of
heath-care workers, questions
arise over which ones. Britain’s
National Health Service, for ex-
ample, employs 1.4 million work-
ers. Not all of them interact with
patients.
Numerous task forces say the
next in line should be the very
aged, who run the greatest risk of
severe illness and death from
covid-19.
Japan aims to distribute vac-
cines in line with medical risks,
with the elderly at the very front
of the line, the Health Ministry
announced this month.
In Europe, health officials ap-
pear likely to tilt toward early
inoculation of residents and care-
givers in nursing homes, where
the virus has taken its greatest
toll — and where governments in
Belgium, Britain, Spain and else-
where have been embarrassed by
their failure.
From there, the trade-offs be-
come more fraught.
“The low-hanging fruit, as it
were, is blindingly obvious, but
then it gets tricky,” said Paul
Hunter, professor in medicine at
the University of East Anglia.
“You want to protect heath-care
workers and residents of care
homes, clearly. Then the extreme-
ly vulnerable. That’s easy. Then
essential workers? That could be
a very large group,” Hunter said.
“I am glad I don’t have to make
these decisions, but someone
does.”
Experts say the decisions
should be transparent and based
on criteria accepted by society,
not just officials or politicians.
Understanding why govern-
ments are favoring one group
over another may be crucial in
getting citizens to roll up their
sleeves for a shot — or patiently
wait their turn.
Germany’s vaccine commis-
sion said it will, before the end of
the year, present a research-
backed ranking with more details
about who will be given early
access. “With evidence-based
reasons we will make transpar-
ent why priority rankings are
assigned to particular groups,”
VACCINE FROM A1
the German commission said. It
added that the ranking would be
adjusted with new scientific evi-
dence or new vaccines.
In France, the public is being
actively consulted on priorities.
In Britain, they are not — which
has led to complaints of unfair-
ness from unions.
In the House of Lords in the
British Parliament recently, Dale
Campbell-Savours, a Labour lord,
pleaded that “absolute priority”
be given to “the vulnerable, itin-
erant, homeless and occupants of
night shelters.”
“That is the least we can do for
those in need,” he said.
Colin Moynihan, a Conserva-
tive Party lord, had his own pitch,
pressing that priority be given to
the athletes and their entourages
seeking to represent Britain in
the 2021 Olympic Games in To-
kyo.
For its part, Japan has prom-
ised to offer vaccines to the entire
population by the middle of 2021
— which would be in time for the
Olympics — and has preordered
supplies from various potential
vaccine manufacturers.
Philip Clarke, a health econo-
mist at the University of Oxford,
said the urgency of the priority
lists will depend on how long it
takes for vaccines to become
widely available.
“Meaning if everyone has ac-
cess to a shot over a period of
weeks, it might not matter who
goes first or last,” he said. “But if
vaccines are rolled out slowly,
over many months, it might mat-
ter very much who goes first or
last.”
For smaller and poorer coun-
tries that couldn’t afford to put in
preorders before vaccines were
approved, the hierarchy will be
even more critical.
Clarke said he has been sur-
prised that there has not yet been
a wider public debate in most
societies — as it could be literally
a matter of life or death, for
individuals and economies.
In Britain, after vaccinating
medical workers and nursinghome residents, the government
is leaning toward distributing
the vaccine by age group — the
over 80s, followed by over 75s,
over 70s, over 65s — before ex-
tending it to other at-risk groups.
Clarke said allocating by age
was “verifiable and simple,” and
the public may trust such an
approach, “but you might pre-
vent more covid and save more
lives with better lists.”
He said in Britain, some occu-
pations were clearly more risky
than others. “The first wave of the
pandemic showed security
guards and delivery drivers had
worse mortality rates than
health-care workers.”
Germany’s vaccine commis-
sion said shots should be given to
people whose work in society fills
“especially relevant functions
and that aren’t easily replace-
able.” Although many people
think they are irreplaceable, Ger-
many suggests these workers are
public health officers, police, fire-
fighters and teachers.
In China, officials want to in-
clude port workers, who provide
the vital service of loading and
unloading the cargo ships that
power their trade.
In Indonesia, the government
is emphasizing protecting young-er workers, to keep the economy
going.
How about political leaders?
Should members of the House
and Senate — or members of the
German Bundestag, British Par-
liament and National People’s
Congress in China — get priority
access, outside of considerations
for age and health?
In its early guidelines, the
World Health Organization said
yes, early access for government
leaders makes sense, but it cau-
tioned that the favored should
include “a very small number of
individuals.”
Russia — where President
Vladimir Putin’s daughter has
been vaccinated — may have
already surpassed those limits.
Russia has administered thou-
sands of doses of its Sputnik V
vaccine. Health workers on covid-19 wards were among the first
recipients. More than 45,000 of
them have been given shots, ac-
cording to Alexander Gintsburg,
director of the Gamaleya Nation-
al Center of Epidemiology and
Microbiology, which developed
Russia’s vaccine.
Bloomberg News reported in
July that Russian politicians, offi-
cials and oligarchs were given
access to the vaccine beginning
in April, before it was registered.
Health officials deny that
claim. But many senior Russian
officials have been vaccinated by
now, including Defense Minister
Sergei Shoigu and Moscow May-
or Sergei Sobyanin. Sobyanin
said it would have been difficult
for him to campaign in favor of
the vaccine if he did not get it.
In China, the calculation of
who gets vaccinated first has
been different than in the West,
as the main risk is imported
cases. China has largely quashed
the domestic spread of the virus
through exhaustive measures,
such as testing every resident in a
city when a new cluster emerges.
China has put citizens with
overseas travel plans among the
groups prioritized for emergen-
cy-use vaccines. Aside from pre-
venting its citizens from bringing
the virus back home, it also
reduces the risk of Chinese na-
tionals becoming carriers of the
virus overseas, at a time when
anti-Chinese sentiment is high in
many places because of the pan-
demic’s origins in China.
China’s vaccine allocation has
also been affected by the fact that
it began emergency use long
before the experimental vaccineswere proven to be safe and effec-
tive. They still haven’t been — at
least not in any medical journal.
So the first groups to gain
access in China were those who
could be relied on to accept
personal risks on behalf of their
nation: soldiers, diplomats,
workers in state-owned enter-
prises and employees of the vac-
cine makers themselves.
Sinovac Biotech’s chief execu-
tive said in September that
90 percent of his company’s em-
ployees and their families had
taken their experimental vaccine.
Zheng Zhongwei, an official at
China’s National Health Commis-
sion, said last month that the
general population had been
classified for vaccine access into
three tiers: those in high-risk
work environments, vulnerable
groups and the general public.
Vulnerable groups include chil-
dren in China.
“No matter which region they
are in, if they meet these charac-
teristics, they should be given
priority for the vaccine,” he said.
Another alternative might be
to focus less on people’s charac-
teristics, but regions. In some
countries, governments could
target hot spots first, or focus on
dense urban populations vs.
those more isolated in the coun-
tryside.
Penny Ward, a visiting profes-
sor in pharmaceutical medicine
at King’s College London, said
the allocation of vaccines in vari-
ous countries may depend on
what the vaccines turn out to do
best.
Ward said Britain’s focus on
inoculating the elderly is based
on the presumption that the vac-
cine will, predominantly, protect
against illness rather than pre-
vent infection entirely. And so
British officials are targeting peo-
ple most likely to suffer serious
illness, requiring hospital care,
and death.
“This approach also requires a
lower proportion of the popula-
tion to be vaccinated than would
be required if the strategy were to
be to prevent infection and cut
short community outbreaks,
which would require vaccination
of a high proportion of the entire
population,” she said.
Yet another approach would
be to go random. In the 2011 film
“Contagion,” the world is saved
by a vaccine, made from an
attenuated virus, which is dis-
tributed to the public by a lottery
based on birthdays, not age.
It is not a far-fetched idea.
Randomization, or a weighted
lottery, has been used to distrib-
ute scarce, lifesaving drugs in the
past — most recently the alloca-
tion of remdesivir to treat severe-
ly ill covid-19 patients.
[email protected]
[email protected]
[email protected]
[email protected]Dou reported from Seoul, Dixon
reported from Moscow and Beck
reported from Berlin. Simon Denyer
in Tokyo, Liu Yang in Beijing, Joanna
Slater in New Delhi, Gabriela
Martinez in Mexico City and Terrence
McCoy in Rio de Janeiro contributed
to this report.Nations weigh fairness, speed in vaccination prioritization
MARTIN BUREAU/ASSOCIATED PRESS
Nursing home workers await French Health Minister Olivier Véran this month in Clamart, France. In Europe, health officials appear
likely to tilt toward early inoculation of residents and caregivers in nursing homes, where the virus has taken its greatest toll.HENRY NICHOLLS/REUTERS
Volunteers offer food to a homeless man in London. A politician
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